Caregivers’ knowledge, perceptions and practices on diarrheoal diseases among children under five years in Turkana County, Kenya.

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ABSTRACT
Diarrheoa disease is the major cause of morbidity and mortality among under-five children, especially in developing countries. In Kenya, it causes 16% of deaths among children under five years, second only to pneumonia. The aim of this study was to assess caregivers’ knowledge, perceptions and practices in the management of diarrheoa among children under five years in Turkana County. A cross-sectional study design was employed in the study. Pre-tested questionnaires and Key Informant Interview guide were used to collect data. A multi-stage cluster sampling technique was used to select a total of 340 households, while purposive sampling was used to select 20 key informants who participated in the study. Descriptive statistics and Chi-square test of independence were used to analyze quantitative data with the aid of SPSS. Qualitative data were thematically analyzed by using Nvivo software. Baseline characteristics reveal that caregivers’ had diverse backgrounds with majority aged 21-25 years (27.1%), married (83.2%) and had primary school (34.7%) as the highest education level. Age of under fives also varied with majority aged 12-24 years (49.6%). Findings showed diarrheoa prevalence of 16.5%. On socio-demographic factors, only level of education had a statistically significant relationship with diarrheoa prevalence(𝑝 = 0.014). Caregivers’ perceptions that were significantly associated with diarrheoa prevalence included perceptions that diarrheoa is not a serious disease to be treated at the hospital(𝑝<0.001), traditional medicine is adequate to treat diarrheoa(𝑝<0.001), children should be treated at home before taking them to the hospital(𝑝<0.001), supernatural causes (𝑝<0.001), and growth stage such as teething(𝑝<0.001).Caregiver’s knowledge that was significantly related to diarrheoa prevalence included: knowledge that diarrheoa can be adequately managed at home(𝑝= 0.31),contaminated water or food causes diarrheoa(𝑝<0.001), poor hands hygiene causes diarrheoa(𝑝<0.001), poor fecal disposal causes diarrheoa (𝑝<0.001), poor feeding causes diarrheoa (𝑝<0.001) and knowledge on prevention of diarrheoa (p<0.001) were significantly related to diarrheoa prevalence. In regard to caregivers’ practices, there was a statistically significant relationship between diarrheoa prevalence and use of clean drinking water (𝑝<0.001), hand washing after defecation (𝑝<0.001), hand washing before feeding children (p<0.001), hand washing before food preparation (𝑝<0.001), hand washing after helping children to defecate (𝑝<0.001), ensuring proper hygiene (𝑝<0.001), use of pit latrines to dispose feces (𝑝<0.001), proper disposal of feces (𝑝<0.001), and disposal of child's feces (𝑝<0.001). In conclusion, there is a high burden of diarrheoa in Turkana County mainly due to caregivers’ negative and wrong perceptions coupled with caregivers’ inadequate knowledge towards diarrheoa and its causes. Recommendation was that there is need for increased health communication, education and information sharing to demystify the disease and promote adoption of appropriate and effective diarrheoa management practices.